Chronic Inflammation 2

Question 1

What is granulomatous inflammation always characterised by?

Answer 1

Granulomas (granulomata) in tissues and organs

Question 2

How is Granulomatous inflammation stimulated?

Answer 2

Stimulated by indigestible antigen, body cannot get rid of it

Question 3

What are idiopathic diseases?

Answer 3

Diseases which we don’t know why they happened.

Question 4

How are granulomas formed?

Answer 4

aggregates of epithelioid macrophages in tissue

Question 5

What is epitheliod?

Answer 5

Looks like epithelial

Question 6

What might granulomas surround?

Answer 6

Giant cells, dead material

Question 7

What might granulomas be surrounded by?

Answer 7

lymphocytes

Question 8

What do granulomas contain?

Answer 8

neutrophils, eosinophils

Question 9

Granulomas are formed as a result of?

Answer 9

response to indigestible antigen

Many are type 4 hypersensitivity reactions

Question 10

What do giant cells consist of?

Answer 10

A giant cell is a mass formed by the union of several distinct cells (usually macrophages)

Question 11

Describe the structure of a giant cell?

Answer 11

large cytoplasm; multiple nuclei

- several types

Question 12

Are there always granuloma for giant cells to be present?

Answer 12

no

Question 13

Name a type of giant cell

Answer 13

Langhans type

Question 14

What is a Langhans type giant cell classically found in?

Answer 14

TB

Question 15

Describe the structure of Langhans type

Answer 15

peripheral rim of nuclei

large eosinophilic cytoplasm

Question 16

What is the giant cell often associated with pyogenic granulation tissue

Answer 16

Foreign body type

acutely inflamed
neutrophils, pus
organisation
giant cells

Question 17

What type of giant cell might you see with a ruptured silicone implant? e.g breast implant

Answer 17

Silicone associated giant cells

Vacuoles contain leaked silicone

Question 18

Name some Infectious granulomatous diseases

Answer 18

Tuberculosis (Mycobacterium tuberculosis),

Leprosy Mycobacterium leprae

syphilis

Question 19

Describe Caseous necrosis

Answer 19

Cell death in which the tissue maintains a cheese-like appearance. Dead tissue appears as a soft and white proteinaceous dead cell mass.

Dead tissue surrounded by macrophages, giant cells, lymphocytes

No neutrophils?

Feature of TB?

Question 20

Give examples of Non-infective granulomas

Answer 20

rheumatoid disease - tissue specific auto-immune disease

sarcoidosis

Crohn’s disease – chronic inflammatory bowel disease

Question 21

What is Sarcoidosis?

Answer 21

Development of granulomas within organs of the body

Question 22

What are the common processes in chronic inflammation?

Answer 22

Acute inflammation
Granulation tissue formation
Local angiogenesis - new vessels grow
Fibrosis and scar formation

Question 23

What is surgical wound healing?

Answer 23

Healing by primary intention

Question 24

What are the goals of surgical wound healing?

Answer 24

Minimal gap, small amount of granulation tissue, small linear scar

Question 25

What is healing of larger defects?

Answer 25

Healing by secondary intention

Question 26

Describe the granulation tissue ingrowth in larger defects

Answer 26

Lots of it Contraction and scarring

Question 27

What is the sequence of events in wound healing?

Answer 27

- injury, blood clot, acute inflammation, fibrin - many growth factors and cytokines involved - granulation tissue growth - angiogenesis - phagocytosis of fibrin - myofibroblasts move in and lay down collagen - contraction of scar - re-epithelialisation

Question 28

What conditions favour wound healing?

Answer 28

Cleanliness Apposition of edges (no haematoma) Sound nutrition Metabolic stability and normality Normal inflammatory and coagulation mechanisms Note local mediators

Question 29

What conditions result in impaired wound healing?

Answer 29

Dirty, gaping wound, large haematoma Poorly nourished, lack of vitamins C, A Abnormal CHO metabolism, diabetes, corticosteroid therapy Inhibition of angiogenesis

Question 30

What is the sequence of events in fracture healing?

Answer 30

Trauma, fracture, haematoma Bits of dead bone and soft tissue Acute inflammation, organisation, granulation tissue, macrophages remove debris Granulation tissue contains osteoblasts as well as fibroblasts

Question 31

What are the stages of callus formation?

Answer 31

Osteoblasts lay down woven bone Nodules of cartilage present Followed by bone remodelling: osteoclasts remove dead bone progressive replacement of woven bone by lamellar bone reformation of cortical and trabecular bone

Question 32

What stimulates proliferation of vessels?

Answer 32

Vascular endothelial growth factor, released by hypoxic cells, stimulates proliferation

Question 33

What aids the process of angiogenesis?

Answer 33

Enzyme secretion

Question 34

What is the benefit of angiogenesis?

Answer 34

Allows blood supply to enter damaged tissue

Question 35

What is the effect of angiogenesis on thrombus

Answer 35

Grows vessels through the thrombus, limits its propagation

Question 36

What is the effect of angiogenesis in malignant tumours

Answer 36

angiogenesis occurs as tumour grows, | potential for therapeutic control